To what extent do general practitioners involve patients in decision-making? A systematic review of studies using the OPTION-instrument.

Abstract

Aim: This systematic review aimed to analyze studies assessing the extent to which General Practitioners (GPs) engage patients in the decision-making process during consultations.

Background: Shared Decision Making (SDM) stands at the core of patient-centred care, particularly in primary healthcare, where a diverse array of medical decisions transpires. In a 2015 systematic review summarizing studies on the Observing Patient Involvement in Decision Making (OPTION) instrument to assess SDM objectively across healthcare settings, a notable dearth of patient involvement was observed.

Methods: A comprehensive literature search encompassing three digital databases was conducted up to November 2023. Inclusion criteria focused on studies employing a comparative study design, centric to primary healthcare, and utilizing the OPTION-5 or -12 instrument to gauge SDM levels. Two investigators independently performed study selection, risk of bias assessment, and data extraction using a list of predefined variables, with discrepancies resolved by a third reviewer. PROSPERO registration-ID: CRD42023475419.

Findings: Initially, harvesting 447 articles, our review retained 29 studies published between 2003 and 2022. Mean age of GPs was 45.5 (range 33-53) years. Reported baseline OPTION scores varied between 1.5 and 57.2 on a 0-100-point scale, with a median score of 16. Following SDM interventions, OPTION-scores increased significantly to a median of 28.5, range 16-83.

Conclusion: The overall level of SDM among GPs remains relatively low and has shown minimal improvement over the past decade. However, interventions promoting SDM appear to enhance patient involvement levels. This underscores the necessity for increased education and tools, directed at GPs and patients, to foster and elevate the practice of SDM.